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CC BY 4.0 · Endosc Int Open 2025; 13: a25210084
DOI: 10.1055/a-2521-0084
Original article

Endoscopic transpapillary gallbladder stenting vs percutaneous cholecystostomy for managing acute cholecystitis: Nationwide propensity score study

Chun-wei Pan
1   Internal Medicine, Cook County Hospital, Chicago, United States (Ringgold ID: RIN25430)
,
Daryl Ramai
2   Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, United States (Ringgold ID: RIN1861)
,
Azizullah Beran
3   Gastroenterology and Hepatology, Indiana University, Bloomington, United States (Ringgold ID: RIN1772)
,
Yichen Wang 
4   Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, United States (Ringgold ID: RIN14640)
,
Yuting Huang 
5   Gastroenterology & Hepatology, Mayo Clinic in Florida, Jacksonville, United States (Ringgold ID: RIN156400)
,
John Morris
6   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)
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Abstract

Background and study aims

Cholecystectomy is the standard treatment for acute cholecystitis, but it may not be suitable for all patients. For those who cannot undergo surgery, a percutaneous cholecystostomy tube (PCT) and ERCP-guided transpapillary gallbladder drainage are viable options. We aimed to perform a nationwide study to assess 30-day readmission rates, adverse events (AEs), and mortality rates in these two cohorts.

Patients and methods

We conducted a nationwide cohort study using data from the Nationwide Readmissions Database (NRD) from 2016 to 2019. We identified patients with acute cholecystitis during the index admission who underwent either PCT or ERCP-guided gallbladder drainage. Propensity score matching along with multivariable regression was used to compare cohorts.

Results

During the study period, 3,592 patients (average age 63.0 years) underwent endoscopic drainage, whereas 80,372 patients (average 70.8 years) underwent Interventional Radiology drainage. Utilizing multivariate Cox regression analysis, compared with ERCP, PCT had a higher risk for 30-day readmission (adjusted hazard ratio [aHR] 1.47; 95% confidence interval [CI] 1.27 to 1.71; P < 0.001). The PCT group had a significantly higher rate of readmission for acute cholecystitis compared with the ERCP group (2.72% vs 0.86%; P < 0.005). Cox proportional hazard ratio showed a 3.41-fold increased risk (95% CI 1.99 to 5.84) for readmission in the PCT group. ERCP was consistently associated with lower rates of post-procedural AEs compared with PCT including acute hypoxemic respiratory failure (P < 0.001), acute renal failure (P < 0.001), shock (P < 0.001), and need for blood transfusions (P < 0.001).

Conclusions

Our nationwide analysis revealed that ERCP-guided gallbladder drainage should be the preferred approach for managing acute cholecystitis when unfit for surgery.

Keywords

Pancreatobiliary (ERCP/PTCD) - ERC topics - Endoscopic ultrasonography - Biliary tract

Supplementary Material



Publikationsverlauf

Eingereicht: 17. Oktober 2024

Angenommen nach Revision: 15. Januar 2025

Accepted Manuscript online:
20. Januar 2025

Artikel online veröffentlicht:
26. Februar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Chun-wei Pan, Daryl Ramai, Azizullah Beran, Yichen Wang, Yuting Huang, John Morris. Endoscopic transpapillary gallbladder stenting vs percutaneous cholecystostomy for managing acute cholecystitis: Nationwide propensity score study. Endosc Int Open 2025; 13: a25210084.
DOI: 10.1055/a-2521-0084
 

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